前颅窝脑脊液漏经颅修补术

                               
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Transcranial subfrontal approach by  preserving olfactory nerves  for CSF rhinorrhea

Prof. Dr. Selçuk YILMAZLAR
Uludag University, School of Medicine, Neurosurgery Department, Bursa TURKEY

CSF rhinorrhea is one of the serious complication associated with skull base fracture, endoscopic nasal surgery , and spontaneous CSF leakage.  Likelihood meningitis is  a significant cause of mortality and permanent disability in these patient. Our patient had been operated in another center with the diagnosis of sinusitis 10 years ago.  Initially conservative methods such as lumbar CSF drainages and bed rest and then endoscopic transnasal surgical attemps should be given to the patients, if they fails, transcranial-subfrontal approach has good outcome with less chances of complications. A 50-year-old woman underwent a sinusitis surgery 9 years ago. Three months prior to hospitalization, she has experienced obvious delayed rhinorrhea. Paranasal sinus CT and MRI revealed a  defect at the left side of crista galli.  Endoscopic approaches had been tried before another center but had not been successful so, transcranial repair was performed with bilateral subfrontal approach by  preserving olfactory nerves.
After surgery, there was no  CSF leakage. This video demonstrates the detailed technique of using such an approach. We may conclude that the subfrontal transcranial approach to the whole anterior skull base defects (large or small defects) is a safe and effective procedure for the CSF rhinorrhea.